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Updated Aug 26, 2024

In This Section
This section contains the topic, “Insanity Determinations.”

1.  Insanity Determinations

Introduction
This topic contains information on the effect of insanity on administrative decisions, including

Change Date

 August 26, 2024

X.iv.2.A.1.a.  Effect of Insanity on VA Benefits

 If a Veteran was determined to be insane at the time of commission of the act or acts that would otherwise result in an adverse character of discharge (COD), line-of-duty (LOD), or willful misconduct determination, hold that the Veteran
  • was without fault, and
  • is not precluded from any Department of Veterans Affairs (VA) benefits.
References:  For more information on

X.iv.2.A.1.b.  Placing Insanity at Issue

 Insanity is placed at issue in the following ways:
  • by specific allegation by the Veteran or an authorized representative
  • by the VA employee if the evidence indicates the possibility of insanity, or
  • if suicidal death occurs in service.
Note:  The possibility of insanity is raised by the record if there is evidence showing that
  • the individual had a qualifying disease (excluding personality disorder or mental deficiency), and
  • such qualifying disease caused one or more of the following at the time the offense(s) in question took place:
    • a more or less prolonged deviation from the individual’s normal method of behavior
    • interference with the peace of society (disruptions of legal order), or
    • antisocial departure from, and inadaptability to, the accepted standards of the community to which the individual belongs by birth and education.
Important:  The mere diagnosis of a mental condition is not sufficient on its own to place insanity at issue.  The development activity should not refer a case to the rating activity for an insanity determination without evidence showing the individual potentially met the definition of insanity under 38 CFR 3.354(a), as described above, or without having fully developed for facts and circumstances.
Reference:  For more information on the

X.iv.2.A.1.c.  Developing Cases in Which Insanity Is an Issue

 If insanity is at issue, develop the case completely before making a determination. Obtain the following information when developing:
  • all service and post-service treatment records that are in any way relevant, and
  • complete transcripts of any court martial or board proceedings that may be relevant.
References:  For more information on obtaining

X.iv.2.A.1.d.  Referring a Case for Rating Action
After completing development, refer the case to the rating activity if the issue of insanity is raised as described in M21-1, Part X, Subpart iv, 2.A.1.b, and use the table below to determine how to process the resulting decision.
If the insanity determination is relevant to the issue of …
Then the rating activity …
  • COD
  • LOD, or
  • willful misconduct
  • prepares a rating decision in which the issue of insanity is the sole issue, and
  • routes its rating decision to the development activity to support preparation of an administrative decision.
in-service suicide
  • prepares a formal rating decision granting or denying service-connected death, and
  • routes its rating decision to the authorization activity for final award or denial action.
Important:  The rating activity is not required to make a formal decision on the issue of insanity when the matter is neither claimed nor appropriately raised by the record, as described in M21-1, Part X, Subpart iv, 2.A.1.b.  If the rating activity does not believe the facts of the case raise the possibility of insanity, then the rating activity should
  • return the claim for continuation of the administrative decision process, and
  • document the finding that referral for an insanity determination was inappropriate by entering a note in the Veterans Benefits Management System.
Notes:
  • When resolving the issue of insanity,
    • apply the
    • state in the Narrative of the rating decision, The Veteran [was] [was not] insane at the time of commission of the offense.
  • A rating decision finding the Veteran to have been sane at the time in question, supported by the necessary explanation, is sufficient as to the particular period of service or offense at issue.
  • Determinations of insanity are adjudicative decisions that must be premised on existing regulatory provisions and agency policies.  Do not routinely rely on medical assessments and opinions to resolve the legal question of insanity for VA purposes.

X.iv.2.A.1.e.  Forgoing a Separate Notice of a Rating Decision Addressing Insanity Only
Rating determinations regarding insanity are rendered solely to influence and inform the preparation of subsequent administrative decisions.  As such, do not prepare or release a decision notice to communicate the outcome of a rating decision that addresses, as a solitary issue, the question of a Veteran’s (or former service member’s) insanity.
If the rating activity resolves the question of insanity unfavorably (that is, deeming the Veteran or former service member sane at the time of commission), briefly discuss this factor in preparing the administrative decision notice required in

X.iv.2.A.1.f.  Preparing an Administrative Decision
When a rating decision is received, whether or not insanity is established, the development activity must prepare an administrative decision concerning COD, LOD, or willful misconduct for approval, as required.
Important:  All subsequent action must be based on this determination or on a formal rating decision that may have been made.
References:  For more information on administrative decisions for